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DIRECTIVE No. 03/1999/CT-BYT OF MARCH 10, 1999 ON STEPPING UP THE EXECUTION OF THE 1999 HEALTH PLAN SO AS TO ACHIEVE THE OBJECTIVES SET IN THE RESOLUTION OF THE 8th PARTY CONGRESS ON HEALTH CARE FOR PEOPLE

In materialization of the Resolution of the 8th Party Congress and Resolution No.37/CP of the Government on the strategy on health care and protection for the people in the 1996-2000 period and Vietnam’s national policy on medicines, the health service has recorded many important achievements. The basic indices on our people’s health are much higher than those of other countries having the same income level. However, besides the gained achievements, we have still met with numerous difficulties and problems in disease prevention and treatment, personnel training and scientific research.

In order to promote the gained achievements and overcome shortcomings and budget difficulties to well implement the 1999 plan and achieve the major objectives set for the year 2000, the Health Minister instructs the provincial/municipal Health Services, units attached to the Health Ministry, health stations of the ministries and branches as well as managers of national target health programs (called units for short) to direct and well perform a number of the following tasks:

1. Stepping up the work of prophylactic hygiene and taking initiative in combating such epidemics as dengue fever, malaria, typhoid, encephalitis, cholera, plagues... by the following basic measures:

a) To carry out right from the beginning of the year activities for environmental hygiene, well settle the sanitation issues and apply measures to control transmission vectors.

b) To further strengthen the epidemic control system at all levels in order to take initiative in preventing epidemics. For localities highly prone to epidemics, attention should be paid to epidemics detection and notification to higher levels for timely handling measures.

c) To quickly adopt measures to prevent and combat dengue fever, to continue stepping up the HIV/AIDS prevention and combat and promote the results obtained in preventing and combating other epidemics; not to let big epidemics occur and if an epidemic disease takes place, all measures must be applied to stamp it out. To strive to reduce by 30% of the epidemics catchers and 10% of dead patients as compared to 1998.

d) For provinces where cholera is rampant, efforts should be concentrated to stamp it out, minimizing the number of sufferers and dead patients. For provinces prone to the epidemic spread, strict quarantine measures should be applied to prevent the epidemics from spreading thereto; if an epidemic occurs, measures should be taken to control and stamp it out.

2. Raising the quality of medical examination and treatment

a) Stepping up the education of the 12-article regulation on medical ethics among the contingent of medical workers and strictly enforcing the hospital rules so as to raise the quality of medical examination and treatment and reduce troubles for patients. Continuing to well execute the Prime Minister’s Directive No. 661-TTg of October 17, 1995 on immediate examination and treatment for patients in emergency cases and trauma; the Health Minister’s Directive No.11 CT-BYT of December 11, 1995 on improvement of the service of in-patients and Directive No.08/1998/CT-BYT of November 6, 1998 on prevention and urgent treatment of childbirth complications so as to minimize complications that may occur during the treatment.

b) Reorganizing step by step the medical examination and treatment network in line with the planning of the branch and localities. Depending on the practical situation of each establishment and each locality, the development investment shall be made in three fields: infrastructure, personnel’s qualifications (paying attention to personnel structure in service of community disease model) and equipment.

c) Attaching importance to well implementing the policy of medical examination and treatment for the poor, people with meritorious services done to the country, families entitled to social policies and people of ethnic minorities. For extremely poor people, Joint Circular No. 05/1999/TTLB of the ministries of Health, Finance and Labor, War Invalids and Social Affairs should be well implemented.

d) Reorganizing the work of hospital pharmacy and consolidating the Drugs and Hospitalization Council in order to well implement the Health Minister’s Directive No. 04/1998/CT-BYT on the management and safe, rational and thrifty use of drugs.

e) Well organizing the medical examination and treatment under the health insurance regime, avoiding the discrimination between persons who pay for their own costs of medical examination and treatment as well as hospitalization and persons whose medical examination and treatment as well as hospitalization are paid by the insurers. To well settle problems arising in the implementation of Decree No. 58/1998/ND-CP of the Government promulgating the Health Insurance Regulation.

f) Hospitals shall have to strictly observe the constant sanitation regime, periodically whitewashing walls and repainting doors and windows in order to ensure that the hospitals are always well set up, clean and beautiful.

3. Raising the quality of healthcare for the mothers and children

In 1999, efforts should be concentrated on the program for healthcare for the mothers and children with the following major contents:

a) To care for the mothers’ health before, during and after their childbirth, ensuring cleanness and safety therein. Each expecting mother is given three fetus checks during a period of pregnancy and at least one check within 42 days after the childbirth, striving to achieve the goal that more than 80% of the mothers are tended by medical workers in their childbirths.

b) To step up the work of information, propagation, medium education and consultation on reproductive health, safe motherhood, clean childbirth among subjects in the fertility age group.

c) To reduce the number of abortions by 25% as compared to 1998 by closely coordinating with the Population and Family Planning Commission at all levels in providing contraceptive services.

d) To coordinate child healthcare programs such as the enlarged vaccination program, ARI, CDD, Vitamin A… in order to reduce the mortality rate among children under one and under five years old to 3.5% and 4.2% respectively. To eliminate polio and infant tetanus by the year 2000.

4. To step up the target programs against child malnutrition in order to cut the malnutrition rate among children under five (weight by ages) by 3% annually with the following active measures:

a) To continue implementing the target programs against malnutrition among children, paying attention to poor localities with high rates of malnourished children; to adhere to the objectives defined in Decision No.244/1998/QD-TTg of November 17, 1998 of the Prime Minister on adding the objectives of preventing and combating child malnutrition to the national target program for elimination of a number of social diseases and dangerous epidemics.

b) To intensify the work of health and nutrition propagation and education among expecting and nursing mothers so as to help them acquire healthcare knowledge for preventing and combating malnutrition for their children most effectively.

c) To build children-friendly hospitals and medical examination rooms, as well as nutrition departments at hospitals in order to quickly restore nutrition for child patients when they have to be hospitalized.

5. Consolidating the grassroots health networks

a) To continue implementing Decree No. 01/1998/ND-CP of the Government on the system of local health organizations and Joint Circular No. 02/TTLT of the Health Ministry and the Government’s Commission for Organization and Personnel guiding the implementation of the above-mentioned Decree. In 1999, priority shall be given to the definitive settlement of the question of medical investment for 1,000 particularly difficult communes among the total of 1,715 poor communes throughout the country with four contents: Building clinics or health stations; having adequate medical equipment; having medical cadres in communes and medical workers in villages and hamlets; having capital for drug trading (on the basis of ODA capital and domestic budget).

b) In order to ensure that by the year 2000, 100% commune health stations have midwives or assistant-doctors in obstetrics and pediatrics, 40% of the communes have physicians and 100% of the villages and hamlets have community-based health workers, the provincial/municipal Health Services shall have to draw up plans therefor and apply a number of measures as follows:

- Organizing refresher courses on obstetrics and pediatrics for general assistant-doctors and on midwifery for nurses; training primary-level midwives at intermediate medical schools who shall be on probation at district health centers and be recruited for communes; working out policies to encourage midwives in low-lying regions to move and work in highland regions.

- Implementing the regime of sending people from communes for being trained into physicians who, after finishing their study, will return to work in communes; rationally rearranging personnel in provincial and district medical establishments so as to be able to post physicians to communes on the rotation basis. At the same time, periodically sending commune doctors to work at clinical departments of the district medical centers so as to raise their professional skills; working out regimes to encourage retired military and civil doctors in localities to work at communes; coordinating with the Ministry of Defense in training doctors for border stations, army units in deep-lying, distant, border or island regions as well as difficult areas, who shall undertake the healthcare for army men and for local people as well.

- Quickly perfecting the hamlet health networks with 5 key requirements:

+ Unifying the hamlet health networks in term of organization, direction, tasks and functions according to the Health Ministry’s regulations.

+ Having their operation contents suitable to the level of cadres in each region.

+ Having timetables for regular meetings with the local medical establishments.

+ Enjoying the regime of monthly allowance from the State budget and contributions by community.

+ Having first-aid kits containing tools and drugs suitable to the professional level of the hamlet health personnel (according to the list prescribed by the Health Ministry).

- The Health Services of the provinces and centrally-run cities should well implement the assignment of plans and norms, particularly to the district health centers and commune health stations; to divide the managerial responsibility through medical norms so as to bring into full play the initiative and creativeness of the grassroots health networks; enhance the direction and supervision so as to help establishments tackle in time difficulties and problems that arise.

6. Management of financial expenditures and budget.

In a situation that the State budget reserved for the health service has not increased but been cut by 10% under the general policy of thrift practice, the heads of units shall have to do the following:

a) To closely supervise and strictly manage the budget expenditures already approved for 1999.

b) To seek ways and means to mobilize capital from other sources for the health service.

c) To step up the administrative reform, to combat corruption, enhance the management of budget, supervise spending, to practice thrift and implement the regulations in Decision No. 248/1998/QD-TTg of December 24,1998 of the Prime Minister on a number of policies and measures for management of the socio-economic development plan and the State budget estimate for 1999 and Circular No. 190/1998/TT-BTC of December 31, 1998 of the Ministry of Finance, guiding the implementation of a number of policies and the management of the 1999 State budget draft.

d) To thoroughly grasp and creatively apply medico-economic measures, to coordinate and efficiently use all existing resources in order to overcome the financial difficulties.

7. To ensure essential drugs for people:

a) To step up the domestic drug production and business, ensuring adequate supply of essential drugs to grassroots health establishments, particularly in deep-lying and remote areas. To pay attention to raising the quality of drugs manufactured domestically. To minimize the import of drugs which can be produced in the country and meet the domestic demand.

b) To intensify the inspection and control of the quality of drugs on the markets, at drug stores as well as medical examination and treatment establishments.

8. To step up the emulation movement: To gradually build good examples and emulation fighters in the health service, seeking for form of operation suitable to local situation and raising the quality of operation of the entire service. First of all, units should launch an emulation campaign to follow the bright example set by Medical Doctor Pham Ngoc Thach, the late Health Minister, as well as good examples of model physicians working in communes.

In addition to the above-mentioned major tasks, in 1999, units should well implement the assigned tasks concerning the personnel training, scientific research, capital construction, development of traditional medicine, blood transfusion safety, food hygiene and safety, disaster combat, combination between military and civil medicines, the inspection of administrative reform, exercise of democracy…, thus making the fullest use of all resources to successfully fulfill the 1999 tasks and creating favorable conditions for the entire service to fulfill and overfulfill the medical and healthcare norms set for the year 2000.

Upon receiving this Directive, all units shall have to promptly organize the implementation thereof and quarterly report on the implementation results to the Health Ministry. Departments under the ministry should examine and urge the implementation by units and localities, joining them in settling in time difficulties so as to well implement the 1999 plan of the entire service.

Minister of Health

DO NGUYEN PHUONG